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HX641 22581 
RC309.N48AS7      A  standard  tuberculo 


RECAP 


Association  of  Tuberculosis  Clinics 
of  the  City  of  New  York, 


A  Standard  Tuberculosis  Clinic 


MIMHI 


T?C3&j.M4# 


As7 


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intljeCttpiOrttigork 

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7       ff  CplWe*  of  Pby 


A   Standard 
Tuberculosis   Clinic 


Issued  by 

The  Association   of  Tuberculosis   Clinics 

of  the   City   of  New   York 

105    East   22nd   Street 

.19  Hi 


(U1 


A    Standard    Tuberculosis    Clinic 

IN  order  to  co-ordinate  and  standardize  the  work  of  the  various 
tuberculosis  clinics  in  New  York,  in  January,  1908,  these 
clinics  at  that  time  nine  in  number,  were  organized  to  form 
an  Association  of  Tuberculosis  Clinics.  To-day  the  Association 
includes  twenty-two  such  clinics  in  its  membership,  six  under  the 
immediate  control  of  the  Department  of  Health,  three  maintained 
by  city  hospitals  and  thirteen  connected  with  private  institutions. 

A  certain  area  of  the  city  is  allotted  to  each  clinic  which 
assumes  the  responsibility'  for  the  treatment  and  home  supervis- 
ion of  the  cases  living  within  its  particular  district.  All  cases 
applying  for  treatment  to  the  clinics  outside  of  their  district  are 
referred  back  to  the  clinic  of  the  district  of  residence.  The 
Association  confines  its  activities  to  the  Boroughs  of  Manhattan, 
Bronx  and  Richmond.  More  recently  the  Brooklyn  tuberculosis 
clinics  have  also  organized  along  similar  lines. 

The  following  recommendations  concerning  the  conduct  of 
clinics  for  the  exclusive  treatment  of  tuberculosis  have  been 
formulated  by  the  Association  of  Tuberculosis  Clinics  of  Xew 
York  City,  and  are  based  upon  the  results  of  a  year's  careful 
intensive  study  of  the  work  of  the  clinics  belonging  to  the  Asso- 
ciation. 

These  recommendations  have  been  grouped  under  appro- 
priate heads,  and  have  to  do  with  the  general  policy  of  admin- 
istration, the  work  of  the  nurses,  the  keeping  of  records,  clinic 
facilities  and  clinic  hygiene. 

An  attempt  has  been  made  to  fix  a  minimum  working  stan- 
dard to  which  tuberculosis  clinics  should  conform  in  order  to 
accomplish  their  work  with  the  greatest  expedition  and  with  the 


least  possible  danger  of  infection  to  physicians  and  nurses  or 
patients  applying  for  examination  who  may  not  be  tuberculous. 

It  is  hoped  that  these  recommendations  may  be  helpful  to 
clinics  that  may  hereafter  be  established  as  well  as  to  clinics  al- 
ready in  operation. 

Floor  plans  of  clinics  showing  a  separate  building  devoted 
exclusively  to  tuberculosis  patients  afe  appended,  also  sample 
signs  and  record  cards  used  in  the  Department  of  Health  Clinics 
and  several  private  clinics  and  recommended  by  the  Association 
for  all  clinics  included  in  its  membership. 

GENERAL  POLICY  OF  ADMINISTRATION. 

The  following  conditions  are  necessary  for  admission  to 
membership  in  the  Association  of  Tuberculosis  Clinics  and 
should  be  considered  as  fundamental  requisites  for  all  special 
tuberculosis  clinics. 

a.  All  tuberculosis  cases  must  be  segregated  from  other  dis- 

pensary patients  and  treated  in  a  separate  class. 

b.  A  graduate  nurse  must  be  assigned  to  this  class  for  the 

purpose  of  maintaining  supervision  over  the  homes 
of  these  tuberculosis  cases. 

c.  The  work  of  the  class  for  new  cases  must  be  limited  to 

the  particular  district  assigned  to  it. 

Each  clinic  should  arrange  for  a  physician  to  visit  and  treat 
in  their  homes  those  cases  who  are  too  ill  to  attend  the  clinic  and 
for  whom  hospital  care  cannot  be  provided. 

Special  provision  should  be  made  for  the  treatment  of  chil- 
dren by  the  establishment  of  children's  clinics  wherever  the  size 
of  the  clinic  would  seem  to  warrant  it. 

"Special  class"  work  should  be  introduced  into  ■  all  large 
clinics  by  classifying  patients  and  treating  them  in  separate  small 
groups. 


The  sputum  of  every  clinic  case  should  be  re-examined  once 
a  month. 

All  cases  should  be  re-examined  at  least  once  a  month  and 
the  result  entered  on  the  records. 

The  physicians  should  use  the  nurse's  report  of  home  condi- 
tions as  a  basis  for  advising  patients. 

Any  patient  refusing  for  any  reason  to  attend  his  or  her 
proper  dispensary,  who  is  not  under  the  care  of  a  private  physi- 
cian, should  be  considered  a  delinquent  case.  Such  cases  absent- 
ing themselves  for  one  month  from  their  clinic  should  be  dis- 
charged as  "delinquent"  cases  and  reported  to  the  Department 
of  Health. 

Clinics  connected  with  general  hospitals  should  endeavor  to 
secure  a  few  beds  therein  for  the  use  of  clinic  patients  in  emer- 
gencies or  while  being  held  under  observation  for  diagnosis,  e.  g., 
during  the  administration  of  the  tuberculin  test. 

NURSES. 

All  supervising  nurses  should  be  affiliated  with  some  local 
relief  organization  in  order  to  better  organize  the  relief  work  of 
me  clinic. 

All  nurses  engaged  for  work  in  tuberculosis  clinics  should 
have  had  training  in  social  work.  There  are  Schools  of  Phil- 
anthropy for  the  training  of  social  workers  throughout  the 
country,  having  special  courses,  which  are  highly  desirable  for 
nurses  wishing  to  take  up  tuberculosis  work. 

If  nurses  are  employed  who  are  without  training  in  social 
work,  it  is  advisable  that  during  the  first  month  of  their  em- 
ployment by  the  clinic,  they  should  give  a  certain  portion  of  their 
time  to  the  work  of  one  of  the  recognized  large  relief  societies. 

Previous  experience  in  tuberculosis  work,  while  not  essential, 
is  a  distinct  advantage. 

The  home  of  every  patient  should  be  visited  at  least  once  a 
month. 


A  clerk  should  be  provided  in  those  clinics  where  the  clerical 
work  of  the  nurses  interferes  with  their  more  specific  duties. 

RECORDS. 

Where  two  or  more  clinics  are  established  in  a  given  locality 
a  uniform  system  of  record  keeping  and  record  filing  should  be 
adopted. 

The  classification  of  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis  should  be  employed  for  record- 
ing the  stage  of  disease  and  condition  on  discharge. 

A  record  of  the  condition  on  discharge  should  be  kept  for  all 
patients. 

A  uniform  system  of  record  keeping  should  be  used  by  nurses 
in  order  to  facilitate  the  compiling  of  monthly  reports. 

CLINIC  FACILITIES. 
Space : 

When  a  tuberculosis  clinic  does  not  occupy  a  special  building 
used  for  no  other  purpose  it  should  be  separated  as  far  as  pos- 
sible from  the  other  parts  of  the  dispensary. 

The  tuberculosis  clinic  proper  should  have  not  less  than  three 
rooms,  one  for  interviewing  and  two  for  examining  patients,  one 
for  men  and  one  for  women. 

In  case  the  clinic  room  or  rooms  are  not  available  outside  of 
clinic  hours,  another  room  should  be  available  for  private  con- 
ferences between  the  social  worker  or  nurse  and  those  patients 
requiring  relief. 

In  connection  with  the  clinic  there  should  be  separate  closets, 
one  for  physicians'  and  nurses'  coats  and  one  for  the  gowns  wTorn 
by  physicians  and  nurses  and  for  the  necessary  clinical  supplies. 

Equipment : 

The  interviewing  room  should  contain  a  sink  with  hot  and 


4 


cold  water,  at  least  two  desks  or  tables,  (one  for  the  physician 
and  one  for  the  nurse),  a  filing  cabinet  for  records,  scales,  extra 
chairs  or  benches  for  use  of  patients  while  waiting  to  have  tem- 
perature and  pulse  taken,  a  suitable  receptacle  for  soiled  gauze 
or  paper  handkerchiefs,  a  metal  screen  and  a  map  showing  the 
various  clinic  districts. 

Where  a  special  room  is  not  available  for  the  examination  and 
treatment  of  throats,  a  screened-off  portion  of  the  interviewing 
room  should  be  fully  equipped  for  this  purpose.  The  use  of  the 
interviewing  room,  where  both  men  and  women  are  received, 
is  recommended  rather  than  either  one  of  the  examining  rooms 
where  patients  may  be  disrobed  and  awaiting  examination,  in 
which  case  the  room  would  not  be  available  for  patients  of  the 
opposite  sex. 

Each  examining  room  should  contain  an  examination  table, 
chairs,  metal  screens  and  sink  with  hot  and  cold  water. 

Staff: 

The  number  of  physicians  in  attendance  should  be  sufficient 
to  allow  at  least  15  minutes  for  the  examination  of  every  new 
case  exclusive  of  the  time  given  to  history  taking,  and  at  least 
six  minutes  to  the  examination  of  every  old  case.  The  payment 
of  salaries  to  physicians  will  aid  materially  in  securing  and  keep- 
ing desirable  men  for  tuberculosis  clinic  work. 

There  should  be  at  least  one  nurse  for  every  100  patients  on 
the  clinic  register. 

CLINIC    HYGIENE. 

Tuberculosis  cases  while  awaiting  admission  to  the  clinic 
rooms  should  be  separated  from  the  other  dispensary  patients, 
either  in  a  separate  waiting  room  or  in  a  separate  portion  of  the 
general  waiting  room. 


In  all  waiting  rooms  for  tuberculosis  patients,  large  signs  m 
several  languages  should  be  displayed,  giving  detailed  informa- 
tion as  to  caring  for  the  sputum. 

Sputum  cups  or  a  proper  substitute  therefor  should  be  fur- 
nished by  each  clinic  to  patients  to  take  home. 

Either  paper  or  gauze  handkerchiefs  should  be  given  by  the 
Registrar  or  Clerk  to  each  patient  at  the  time  of  his  admission 
for  use  at  the  clinic. 

Suitable  receptacles  should  be  provided  in  the  waiting  room 
and  in  each  clinic  room  for  soiled  paper  or  gauze  handkerchiefs. 

No  cuspidors  should  be  used. 

Sanitary  drinking  fountains  or  sanitary  paper  drinking  cups 
should  be  provided  for  the  use  of  tuberculosis  patients. 

Furniture,  as  well  as  floors,  should  be  washed  daily. 

Gowns  with  sleeves  should  be  worn  by  physicians  while  on 
duty  in  the  clinic  rooms. 

Nurses  should  wear  either  gowns  with  sleeves  or  washable 
uniforms  while  on  duty  in  the  clinic  rooms. 

Patients'  mouths  should  be  covered  during  the  time  they  are 
being  examined  by  the  physicians. 

Capes  of  washable  material  should  be  provided  for  each 
patient  while  disrobed  and  awaiting  examination. 


Floor  Plans  and  Sign 


FLOOR  PLAN  OF  A  HEALTH  DEPARTMENT  TUBERCULOSIS  CLINIC. 

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i9 


ASSOCIATION  OF  TUBERCULOSIS  CLINICS 

OF  THE  CITY  OF  NEW  YORK 


St  Lukes 


REPORT    OF    THE 

Clinic  for  the  Month  of - 


Jmne. 


Patients  Receiving  Treatment- 


Under  Observation  1st  of  llonth- 
New  Cases 


Old- Cases  Re- Admitted- 


iao 


-L2- 


20  5 


^LL 


_A±. 


1911 


_£_£_ 


£4-7 


Patients  Discharged. 


_L2L 


*  Patients  Remaining  Under  Observation  Last  Day  of  Month 
Visits  of  Patients  to  Clinic  During  Month 


JJEUL 


_4^i. 


ilSL 


34- 


26 


173 


4-7 


Patients  Receiving  Extra  Diet- 


Patients  Referred  by  Non-Association  Hospitals  and  Dispensaries  _ 


3L2JB-. 


_L£L2L 


24-6 


*0f  these   6  6     msfH  are  suspicions  and  have  not  been  reported  to  the  Department  of  Health. 


Patients  Discharged 

Condition  on  Dischaboe  :  (Patients  tender  treatment  1  month  or  more) 

Apparently  Cured__Q__Arrested t _Improved__<2 Progressive- 

Died_CL_Not  Tuberculous i Undiagnosed Q 


-Tota 


Stage  of  Disease  at  Time  of  Admission:  (Patients  under  treatment  1  month  or  more) 

Incipient_5___Moderately  Advanced    4 ZFar  Advanced ± Doubtful   O 

Not  Tuberculous  _i , . TotaL. 

DuBATION  OF  TbEATMENT 

2-29  Days-J> 1  to  3  Mo._£L— 3  to  6  Mo._ 

2  to  3  Xrs._Q_3  Yrs.  and  over_Q_ Came  Once  . 

Reasons  foe  Dischabge 
Unwilling Q Too  Feeble Q_ 

Working Q        Not  Found L 


-2. 1  to  2  Yra._0 


-Total— l^- 


_Moved__H__Not  Tuberculous 1 

In  Hospital E , In  Sanatoria_4l- 


Transferred 3__ 

In  Other  Care_L 


-Left  City__sL_ 
-Apparently  Cure 


-Attending  Non-Association  Dispensary °_ 

J?_Arrested__ 1 Died Q. 


Total  1? 


Eespectfully  submitted, 


SZrOfi^l&siS 


MONTHLY  REPORT  OF  CLINIC  TO  ASSOCIATION. 
(Reduced — Actual  size  8%  by  11  inches.) 


20 


DIRECTORS  AND  OFFICERS. 

James  Alex.  Miller,  M.D.,  President 
John  H.   Huddlestox,   M.D.,  Vice-President 
Lawrence  Veiller,  Secretary 
Mrs.  Hermann  M.  Biggs 

F.    IvlGRRIS    ^LASS,    M.D. 

Mrs.  J./ Borden  Harriman 
Austin  W.  Hollis,  M.D. 
A.  ]s  toBi,  M.D. 
Miss/  Blanche  Potter 
Antonio  Stella,  M.D. 
b/h.  Waters,  M.D. 


Fraxk  H.   Mann,  Assistant  Secretary 

F.  Elisabeth  Crowell,  Executive  Secretary 


21 


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C28II  14OIM1O0 

RC  309  .1143  As  7 

Association  of  tuberculosis  clinics 


